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02-19-2013 at 11:25 PM
vlagrl29
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vlagrl29 is not online. Last active: 05-21-2013, 11:50 PMSilver

question regarding insurance

I'm getting surgery next month, but have not scheduled it yet.  My doctor works at 2 different places: the hospital and the surgery center.  They were able to get me the contracted amount I would owe with the surgery center.  this is the primary place she works with so that's why they were able to get me the price so easily.  I want to find out how much it will cost at the hospital but am having the hardest time getting that quote from both the hospital and insurance company.  the hospital told me they would bill my insurance $7,000-$8,2000 BUT could not tell me what my responsibility would be.  So then I call my insurance and ask them what my responsibility would be and they told me that they are not allowed to discuss anything more than just benefits on my plan.  I"m SO frustrated.  I've literally called both places 4 times or more and even called my doctor to see if she could help, but she doesn't work directly with the hospital.  I'm nervous to schedule a surgery with the hospital without know how much we are going to pay. 

Does anyone have advice for me?  Last thing I did today was ask to speak with a manager at the insurance company and she didn't call me back so I guess i will be calling her again tomorrow.  If anyone on this board works at a health insurance company I would appreciate feedback.  


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02-20-2013 at 11:56 AM
cincychick...
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cincychick35 is not online. Last active: 05-21-2013, 1:33 PMNewbie

Do you have a Summary Plan Description for your health insurance?  That will give you the breakdown of what the insurance pays and what you pay, generally.  Like an Office Visit the plan will pay 80% and the patient will pay 20% subject (or not) to a deductible.

If you have not been given one, you should ask for one.

Also, maybe you could ask your insurance company the percentage the plan pays for the type of service (surgery center) that will at least give you a rough estimate of the cost.

Good luck kiddo, dealing with insurance companies is not fun. 

 
02-20-2013 at 11:57 AM
ArcadianDr...
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ArcadianDreams is not online. Last active: 05-20-2013, 4:43 PMGold

I think you may be asking them the wrong question somehow. This is something that *is* a matter of benefits. You need to know whether you have a deductible and whether your plan is copays or a split cost (like 80/20, 90/10 etc) plan. These are all things that are spelled out in the summary of benefits you received when you signed up for the insurance. It will probably go something like this - a $xx.xx copay for hospital admission and then the cost split is 90%/10%, up to the legal cap for the year (which would not be reached over an 8k surgery).

If you have a deductible and it hasn't yet been met for the year than you'll probably have to pay at least that amount.


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02-20-2013 at 1:50 PM
vlagrl29
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vlagrl29 is not online. Last active: 05-21-2013, 11:50 PMSilver
yes, i know my plan benefits, ded, co ins, copays, etc.  I want to know how much they will discount the procedure down.  It will go to my ded, but I know I won't pay the full amount.  The surgery center told me the discounted amount I would pay after it's been filed with my insurance, but the hospital can't or won't.  I want to have it done in the hospital because i can have payment arrangements made.  with the surgery center I have to pay half up front and the other half within 3 months after.  I would have to put it on my credit card in this case and I don't want to do that.

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02-20-2013 at 2:17 PM
brij2006
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brij2006 is not online. Last active: 05-21-2013, 10:21 PMBronze

I would get a quote from both places and go with whichever is cheapest.  They will likely be billed the same way to your insurance company, and the cheaper one would mean cheaper coinsurance for you.  Your deductible will still likely apply the same no matter which option you go.

If you will have to put it on a credit card in order to pay, then I would go with the hospital if in the long run it is cheaper to go with their payment plan instead of putting it on a credit card and paying fees and interest.


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02-20-2013 at 3:50 PM
smerka
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smerka is not online. Last active: 05-21-2013, 5:02 PMBronze

When my son had surgery on his kidney, I tried to find out how much it would be so we could plan since we had to pay10%.  I didn't even want specifics, just a ballpark.  I had no idea if it would $10,000 or $100,000.  They for some reason couldn't give me a number.  It wound up being $40,000 but we didn't have to pay anything.  

I think the surgical centers are usually cheaper.  


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02-20-2013 at 4:27 PM
vlagrl29
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vlagrl29 is not online. Last active: 05-21-2013, 11:50 PMSilver
smerka:

When my son had surgery on his kidney, I tried to find out how much it would be so we could plan since we had to pay10%.  I didn't even want specifics, just a ballpark.  I had no idea if it would $10,000 or $100,000.  They for some reason couldn't give me a number.  It wound up being $40,000 but we didn't have to pay anything.  

I think the surgical centers are usually cheaper.  

 

I think its wrong for them not to tell you.  The doc told me that the surgery center would be a little cheaper but not much.  I'm just hesitant to put it all on a dang credit card that has zero balance on it.  No credit card debt here, but it seems something always comes up 


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02-20-2013 at 6:01 PM
Jan8
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Jan8 is not online. Last active: 02-25-2013, 7:45 PMSilver
There is a lot of liability issues with hospitals telling you how much it will cost.  I pray this does not happen but what if they quote you $10,000 and then find out their are complications once the surgery starts and need to charge you more?  Hospitals have learned from experience that it is best not to quote people because even if you say "this is just a quote and it can change...blah...blah...blah" people still get very upset if they are quoted $10,000 and it ends up being $200,000 due to complications.  GL with whatever you decide.


 
02-20-2013 at 9:47 PM
vlagrl29
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vlagrl29 is not online. Last active: 05-21-2013, 11:50 PMSilver
Thanks for your replies.  I try and avoid the doctor at all costs, but this is one time I can't and every time I'm always frustrated with the insurance process.  It gives me such a head ache

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02-21-2013 at 3:49 PM
vlagrl29
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vlagrl29 is not online. Last active: 05-21-2013, 11:50 PMSilver
We got great news today.  The manager at coventry called me back and gave me an "estimate".  Looks like the hospital fee will only cost us around $677:)  of course there still is the doc fee and anestheolgy fee.  But instead of me thinking it will cost $3,000.  It will probably be more like $1500-$1600.  Such a blessing.  Plus I just heard back from my CPA and we will be getting a $1,900 refund which i was not expecting since we are both self employed.  Today was a good day:)

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